Evaluation of the Acceleration and Deceleration Phase-Rectified Slope to Detect and Improve IUGR Clinical Management

Tagliaferri, Salvatore; Fanelli, Andrea; Esposito, Giuseppina; Esposito, Francesca; Magenes, Giovanni; Signorini, M.G.; Campanile, Marta; Martinelli, Pasquale

doi:10.1155/2015/236896

Cited by 15 publications

(11 citation statements)

References 30 publications

(48 reference statements)

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“…According to our previous study, chronic hypoxemia is responsible for a delay in the maturation of all the components of the ANS and their integration with the CNS. This delay causes lower values of short‐ and long‐term variability.…”

Section: Discussionmentioning

confidence: 96%

Fetal heart rate monitoring and neonatal outcome in a population of early‐ and late‐onset intrauterine growth restriction

Esposito

Tagliaferri

Giudicepietro

et al. 2019

J of Obstet and Gynaecol

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Aim The early‐onset intrauterine growth restriction (IUGR) is associated with severe placental insufficiency and Doppler abnormalities. The late‐onset IUGR is associated with mild placental insufficiency and normal Doppler velocimetry. The computerized cardiotocographic (cCTG) monitoring is used to evaluate the fetal well‐being in pregnancies complicated by IUGR. Our aim was to investigate the cardiotocographic characteristics of IUGR fetuses and to identify every cCTG difference between Healthy and IUGR fetuses. Methods Four hundred thirty pregnant women were enrolled starting from the 28th week of gestation until the time of delivery: 200 healthy and 230 IUGR fetuses. Fetal heart rate (FHR) baseline (FHR), short‐term variability (STV), long‐term irregularity (LTI), delta, interval index (II), approximate entropy (ApEn), high frequency (HF), low frequency (LF), movement frequency (MF), LF/(HF + MF) ratio (LF/(HF + MF)) and number of decelerations were examined. Newborn baby data were also collected. Results The parameters of short‐ and medium‐term variability discriminate between IUGR and healthy fetuses before 36 weeks including FHR, STV, LTI and delta discriminate between each subgroup of IUGR were compared to each one of the other two (P < 0.05). Conclusion cCTG is a useful tool for the evaluation of chronic hypoxemia, which causes a delay in the maturation of all components of the autonomic and central nervous system. However, cCTG requires integration with fetal ultrasound and Doppler vessels evaluation to improve the ability to predict the neonatal outcome.

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Section: Discussionmentioning

confidence: 96%

Fetal heart rate monitoring and neonatal outcome in a population of early‐ and late‐onset intrauterine growth restriction

Esposito

Tagliaferri

Giudicepietro

et al. 2019

J of Obstet and Gynaecol

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“…In fact, heart control is less reactive in late FGRs than in control group ones. According to some studies [ 25 , 26 ], FGRs had a lower cardiac acceleratory and deceleratory capacity respect to control group ones. This reduced reactivity causes lower values of short- and medium-term FHR variability and also a reduced number of increase and decrease of FHR signal.…”

Section: Discussionmentioning

confidence: 99%

An integrated approach based on advanced CTG parameters and Doppler measurements for late growth restriction management

Esposito

Pini

Tagliaferri

et al. 2021

BMC Pregnancy Childbirth

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Background The clinical diagnosis of late Fetal Growth Restriction (FGR) involves the integration of Doppler ultrasound data and Fetal Heart Rate (FHR) monitoring through computer assisted computerized cardiotocography (cCTG). The aim of the study was to evaluate the diagnostic power of combined Doppler and cCTG parameters by contrasting late FGR –and healthy controls. Methods The study was conducted from January 2018 to May 2020. Only pregnant women who had the last Doppler measurement obtained within 1 week before delivery and cCTG performed within 24 h before delivery were included in the study. Two hundred forty-nine pregnant women fulfilling the inclusion criteria were enrolled in the study; 95 were confirmed as late FGR and 154 were included in the control group. Results Among the extracted cCTG parameters, Delta Index, Short Term Variability (STV), Long Term Variability (LTV), Acceleration and Deceleration Phase Rectified Slope (APRS, DPRS) values were lower in the late FGR participants compared to the control group. In the FGR cohort, Delta, STV, APRS, and DPRS were found different when stratifying by MCA_PI (MCA_PI <5th centile or > 5th centile). STV and DPRS were the only parameters to be found different when stratifying by (UA_PI >95th centile or UA_PI <95th centile). Additionally, we measured the predictive power of cCTG parameters toward the identification of associated Doppler measures using figures of merit extracted from ROC curves. The AUC of ROC curves were accurate for STV (0,70), Delta (0,68), APRS (0,65) and DPRS (0,71) when UA_PI values were > 95th centile while, the accuracy attributable to the prediction of MCA_PI was 0.76, 0.77, 0.73, and 0.76 for STV, Delta, APRS, and DPRS, respectively. An association of UA_PI>95th centile and MCA_PI<5th centile with higher risk for NICU admission, was observed, while CPR < 5th centile resulted not associated with any perinatal outcome. Values of STV, Delta, APRS, DPRS were significantly lower for FGR neonates admitted to NICU, compared with the uncomplicated FGR cohort. Conclusions The results of this study show the contribution of advanced cCTG parameters and fetal Doppler to the identification of late FGR and the association of those parameters with the risk for NICU admission. Trial registration Retrospectively registered.

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“…We used AAC and ADC only, and thus the parameter L was redundant because only the AAC and ADC were considered and not the entire phase rectified curve (only T and S will be reported below). Majority of research has focused on AAC and ADC, while one research group works with the Acceleration Phase Rectified slope (Fanelli et al 2013;Fanelli et al 2014;Signorini et al 2014;Tagliaferri et al 2015). Similarly to AAC and ADC, it characterizes the steepness of the slope of the PRSA curve.…”

Section: Discussionmentioning

confidence: 99%

Effect of signal acquisition method on the fetal heart rate analysis with phase rectified signal averaging

et al. 2016

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Phase rectified signal averaging (PRSA) is increasingly used for fetal heart rate (FHR) monitoring, both with traces acquired with external Doppler cardiotocography (D-FHR), and with transabdominal fetal electrocardiography (ta-FHR). However, it is unclear to what extend the acquisition method influences the PRSA analysis, whether results from using one acquisition method are comparable to those based on FHR acquired by the other method, and if not, which should be the preferred method. To address these questions, we applied PRSA analysis to 28 antepartum synchronous recordings of the FHR using simultaneously D-FHR and ta-FHR. The data included late-onset intrauterine growth restricted (IUGR) fetuses (n = 20) and non-IUGR fetuses (n = 8), all of them at gestation ⩾34 weeks. PRSA analysis depends on two parameters intrinsic to the algorithm, T and S. We analyzed the data using parameters that included all values adopted by other researchers previously (derived from a literature search in PubMed and Google Scholar). T and S were adjusted for the difference in acquisition techniques. We found that the correlation between PRSA analysis based on D-FHR and ta-FHR decreased with decreasing values of the PRSA parameters T and S. Therefore, the acquisition technique affects PRSA values for high resolution PRSA (low values of T and S). In conclusion, for low resolution PRSA, the results from both acquisition methods are comparable. Because ta-FHR signals provide beat to beat data and thus capture more subtle differences in the heart rate variation than D-FHR signals (pre-processed by commercial monitors), we assumed that ta-FHR may provide potentially valuable extra information compared to D-FHR. However, no parameter settings or acquisition method seemed to have a diagnostic value for identifying the late-onset IUGR babies in our dataset.

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Evaluation of the Acceleration and Deceleration Phase-Rectified Slope to Detect and Improve IUGR Clinical Management

Cited by 15 publications

References 30 publications

Fetal heart rate monitoring and neonatal outcome in a population of early‐ and late‐onset intrauterine growth restriction

Fetal heart rate monitoring and neonatal outcome in a population of early‐ and late‐onset intrauterine growth restriction

An integrated approach based on advanced CTG parameters and Doppler measurements for late growth restriction management

Effect of signal acquisition method on the fetal heart rate analysis with phase rectified signal averaging

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